PICC延续性照护服务现状及制约因素分析

The status and barriers of continuity of care for maintaining the patency of PICC

目的从患者和社区医疗机构层面了解PICC延续性照护服务现状并分析制约因素,为PICC维护技术在社区医疗机构的推广提供参考。方法对在株洲市3所三级医院进行PICC置管维护的196例患者采用自行设计的问卷进行调查,对10家社区医疗机构负责人进行半结构式深入访谈。结果 88.8%的PICC带管者平时的维护地点为三级医院,31.1%的患者愿意到社区医院进行导管维护,61.2%的患者因社区诊疗技术不足而不到社区医疗机构进行导管维护。访谈共提取6个主题:人力资源不足,相关知识及技术缺乏,担心风险,收费标准缺乏文件依据,缺乏国家政策支持,建议提高医疗风险的保额。结论社区医院PICC维护情况不容乐观,推进PICC维护进社区存在较多的制约因素,政府、三级医院及社区医疗机构应积极采取对策加以改进,以发挥社区医疗机构初级医疗保健作用。

Objective To identify the status and barriers of continuity of care for maintaining the patency of PICC from patient′s and community health care center′s perspectives, and to provide reference for popularizing continuity of care for PICC maintenance in community health care centers. Methods A total of 196 patients who received PICC maintenance in 3 tertiary hospitals were surveyed using a self-designed questionnaire, and 10 managers of community health care centers were invited to participate in semi-structured interviews. Results Nearly ninety percent(88.8%) of the patients received PICC maintenance in tertiary hospitals, 31.1% of them were willing to receive PICC maintenance in community health care centers, but 61.2% of them would not go to community health care center for PICC maintenance because of inadequate skill of community health professionals. Through the semi-structured interviews, 6 themes were identified: deficiency of community health professionals, inadequate knowledge and skills, worry of risk, lack of legal document for charge, lack of national support policy, and advice of increasing medical risk insurance. Conclusion PICC maintenance in community health care center is not satisfactory and is hinderd by several barriers, so the government, tertiary hospital and community health center should actively take measures to solve the problem, thus to encourage and support the community health care center′s role of primary health protection.